Experience

Centene Corporation

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Provider Relations Representative

  • Jun 2011 - Present

  Position Purpose: Responsible for resolving provider inquiries via telephone and written correspondence in a timely and appropriate manner. Position Responsibilities: •Document all activities for reporting and resolution through the customer relationship management application (CRM) •Answer inquiries from providers regarding claim, eligibility, covered benefits, authorization status issues •Provide first call resolution through issue documentation and resolution with appropriate internal resource, follow-up and ensure closure with the contact who initiated the inquiry •Respond appropriately to provider issues and concerns, and provide trending feedback to improve the customer experience •Process customer correspondence and provide the appropriate level of timely follow up •Manage service related follow up items and outstanding tasks in accordance with established turn around times •Provide assistance to provider regarding website registration, navigation and customer related inquires •Educate provider on health plan initiatives during interactions with providers via telephone •Maintain performance and quality standards based on established call experience guidelines •Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations’ team for claim adjustment •Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service , quality improvement and call reduction Show less



UnitedHealth Group

• Hospitals and Health Care
• 700 & Above Employee

• Team Lead/Claims

  • Apr 2008 - Jun 2011



PacifiCare

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Team Lead/Auditor/Claims Dept

  • Dec 2003 - Apr 2008



BENEFIT PLANNERS

• San Antonio, Texas Area

• Claims Analyst

  • Aug 2003 - Dec 2003



Humana

• United States
• Insurance
• 700 & Above Employee

• Team/Supervisor/Claim Dept

  • May 1993 - May 2003